Does anyone else have Medicare Part A AND MassHealth Care Plus? Does it work?

I have both Medicare Part A and MassHealth Care Plus, but I keep getting conflicting information. About half of the MassHealth reps I speak with say that MassHealth Care Plus will not work because I also have Medicare Part A.

Has anyone tried using MassHealth Care Plus while on Medicare Part A?

Did it work?

(I would very much like to go to the doctor, but cannot afford to do so without insurance. I do NOT have Medicare Part B for reasons I would rather not get into.)

MassHealth is what the state of Massachusetts calls its Medicaid program. Once a person, in any state, becomes eligible for Medicare, then Medicaid becomes their insurer of second resort. It will cover what Medicare does not cover. Medicare is the insurer of first resort. Medicaid recipients - in any state - are expected to take full advantage of their Medicare eligibility.

I think what the reps are trying to tell you is that you lose access to MassHealth when you become eligible for Medicare Part B, but fail to enroll in it. They know you are eligible for it because they know you have Medicare Part A. (Being eligible for Part A implies that you are also eligible for Part B.)

Your state expects you to enroll in Medicare Part B, in order for you to continue getting the additional help from Massachusetts Medicaid. The good news is that the State of Massachusetts will pay your Part B premium for you. You qualify for that because your income is low enough for you to qualify for MassHealth. Here is my source for that: What if I cannot afford Medicare? - MassLegalHelp

An excerpt:

If you get MassHealth, it will pay your Part B premium and your Medicare prescription drug coverage, Medicare Part D. You may also be able to get help paying out-of-pocket co-payments to doctors and hospitals.

To get this benefit, you have to enroll in Medicare Part B and initially pay the Part B premium yourself. (It will be deducted out of your Social Security check.) Then you notify your Income Support office that you need help paying the Part B premium. Getting that premium paid by the state, on your behalf, is part of what Medicaid in your state will do for you. It's part of your MassHealth benefit. Eventually, the State of Massachusetts will reimburse you for the initial Part B premiums that you pay while you are waiting for the benefit to kick in. They will pay the Social Security Program who will then apply a credit to your Social Security payments. You'll get the money back in the form of a payment from Social Security, in one or two lump sums.

I do not live in Massachusetts. (I have lots of relatives who do.) I feel confident of what I've just told you because no state is more generous than Massachusetts. My Medicare Part B premium is paid by Medicaid in my state. If your income is low enough for you to qualify for Medicaid in MA, then your state of Massachusetts will do the same thing.

You kind of shot yourself in the foot by not enrolling in Medicare Part B when you initially became eligible. Because you held back from doing that, you will now be charged a sonewhat higher premium to get Part B coverage. That is a penalty, some of which you may have to pay out of you own pocket. That penalty is going to get bigger every year that you hang back. Here is a source:

https://www.cms.gov/Medicare/Medicar...fo/Part-B.html

An excerpt:

Caution: If the beneficiary didn't take Part B when they were first eligible, the cost of Part B will go up 10% for each full 12-month period that they could have had Part B but didn't sign up for it, except in special cases. They will have to pay this penalty as long as they have Part B.

Do yourself a favor. Enroll in Medicare Part B the next time that enrollment is open to do that. It sounds like you've been trying to finesse the system to save money. The result is that you have no coverage for doctor bills . . . and other things. What you're doing is hurting you.

Once you enroll in Part B, then, if your income is low enough, you will have full Medicare and full Medicaid. When you are fully covered by Medicare and MassHealth, which is Medicaid, then you will be eligible to enroll in Care One, which is your state's program to blend your Medicare and Medicaid coverage into one program that will save you even more money.

You are using the term "MassHealth Care Plus," which is a fuzzy term that I don't think really describes what you have. I think that may have been supplanted by current programs.

There is a mistake above. It's not called "Care One." The correct name of that program to blend Medicare and MassHealth is "One Care." Here's a link:

One Care: MassHealth plus Medicare

Excerpt:

One Care is a new and easier option for people with disabilities to get the full set of services provided by both MassHealth and Medicare. With One Care, you have one plan, one card, and one person to coordinate your care.

This program, which you would have to apply for, after getting enrolled in Part B, would pretty much eliminate copayments for seeing a doctor. Then you could afford to get the care you are wanting and, I'm sure, needing.

Okay, I'm starting to understand better what is the meaning of MassHealth CarePlus. It is the expanded Medicaid that Massachusetts created, in response to ObamaCare, to cover low income adults who are under age 65. Unless those adults are disabled, they would not be eligible for Medicare.

During the first 2 years that you received SSDI, you were not eligible, yet, for Medicare, but you may have been eligible for MassHealth. So you could have gotten MassHealth CarePlus without being enrolled in Medicare Part B.

Once you became eligible for Medicare Part B, your MassHealth coverage is forbidden by law to pay any costs that would have covered by Medicare part B, if you had had it. All doctor bills will be your responsibility. I was unable to find a link to support this. There are plenty of links saying a person over age 65 must get Part B, if they want any help from Medicaid on doctor bills. The truth is that disabled people on SSDI, or SSI, who are under age 65, are held to the same expectation.

There is a lot of confusion about this I think because I don't live in Mass yet I had similiar issues in my state.

Medicaid worked UNTIL I got on disability. I was then deemed uneligible for Medicaid.

Medicare then kicked in and because my disability checks are so low, I am eligible for state aid as well, but it is NOT "medicaid". (This is where the confusion comes in as people think they get both Medicare and Medicaid but technically, no, they don't.)

The benefits of state aid include covering my medicare premiums and deductibles. That is all! I cannot get medicaid services. Any doctor that accepts medicare MUST accept the supplemental insurance (even though some will argue that they don't). I am not eligible to see "medicaid" doctors but I am eligible to see "medicare" doctors. Medicaid services typically don't transfer from state to state, but my supplemental state aid DOES (I've called multiple times to confirm this and my out of state doctors have indeed been paid.)

Are you sure you're enrolled in the correct program?

Some people do get full Medicaid on top of getting both Medicare A and Medicare B. In many states, if your income is below a certain level, they will give you Medicaid, as soon as you get on SSDI or SSI. Most people on SSI are getting full Medicare and full Medicaid.

Some people who are on SSDI are not considered poor enough by their states to qualify for full Medicaid. It varies state to state. Some are allowed limited Medicaid benefits.

The type of state aid that pays your Medicare Part B premium for you is a form of Medicaid, though a limited form. Another limited form of Medicaid is one that provides birth control to disabled women, but nothing else. People who get full Medicare and full Medicaid are called "dual eligibles." There are people like that out there.

I was eligible for Medicaid for a short while after I got on SSDI. Then, when I started getting Medicare, my income was considered too high for me to also keep getting full Medicaid in addition to Medicare. My next door neighbor is living on SSI. She gets full Medicare and full Medicaid.

My nextdoor neighbor can go to the dentist on her Medicaid insurance. I can't because I only have limited Medicaid.

Uhm no, you cannot get Medicare if you are only on SSI (supplemental state income), no matter what state you are in. Medicare is reserved for those in the Social Security system, either through disability (SSDI) or retirement. Your neighbor is mistaken or lying to you. Just as you must have earned enough to get into the SSDI system, you must have earned enough to get into the medicare system. It is an insurance program, ie you pay in to get benefits. If you don't pay in, your only option is SSI and you are not eligible for medicare. My guess is that your neighbor is either retired or disabled and actually on SSDI.

In my state, if you are low income you only get your medicare premiums paid for and your deductibles paid for, which makes sense.....more sense than having medicare and medicaid piggybacking because I can just see people seeing medicaid docs that don't accept medicare (or vice versa) and not having their bills fully covered. Thank god I don't live in one of those states because it would be a nightmare. MOST of the docs in my state that accept medicare do not accept medicaid. Medicare is universally accepted because it is the primary health care for seniors and doctors would be shooting themselves in the foot to not accept it. Medicaid is accepted primarily by bottom of the barrel doctors and I'm glad I'm out of that program because care was total crap when I had medicaid. (ie community clinics that are overworked, doctors who weren't accepting new patients, etc.)

And no, again, it is not "medicaid" because if you tell a doctor here that you have medicare and medicaid, they will OUTRIGHT reject you because they do not accept medicaid. I think I know my own state program. LOL. My insurance card does not say "medicaid" on it or anything like it. The program is completely separate....completely. You must qualify for it separately than qualifying for "medicaid".

I'm also wondering if in these other states people are limited to in state services since medicaid typically doesn't cross state lines. That must suck. I'd be terrified to cross state lines b/c if anything happened to me, the medical bills would bankrupt me!

Actually, we are both somewhat confused. Your post above has helped me see where I had some things wrong. I was forgetting that not everybody is eligible to get Medicare, even if they are over 65 or have been on disability income for over 2 years. As you say, you have to have made a certain amount of payment into the system during your working career through payroll taxes. My neighbor, for instance has only worked under the table doing house cleaning. She gets no regular social security or SSDI. Now in her 70s, her income comes from SSI. She is not eligible for Medicare. She gets Medicaid. I was thinking that everyone over 65 gets Medicare, but, as you say, that is not true. You must have paid into it to a sufficient extent. If you have worked enough to qualify for Social Security or SSDI, then you qualify for Medicare, with 2 year waiting period in the case of disability. (Some people qualify on the basis of a spouse's work and payment history.)

Now here is a slight confusion on your part, if I'm understanding what I think I do. SSI does not stand for "Supplemental State Income." It stands for "Supplemental Security Income," and it is basically a welfare program run by the federal government. Here's a source to back that up: https://www.ssa.gov/ssi/

Some states, especially those where the cost of living is high, provide additional money to those of its citizens who are on SSI. Many states arrange this by handing those funds over to the federal government to put into the federal SSI check. Some states pay the amount separately. This extra money is called the State Supplemental Benefit. Here is a link explaining:

What Are State Supplemental Benefits for SSI Disability? | Disability Secrets

Some people do get both a Social Security check (either regular SS, or SSDI) and a SSI check. These are people whose Social Security check, or SSDI check, is very small, meaning below what the federal government pays in SSI. People like that get Social Security (reg or SSDI) plus SSI (to add up to what SSI pays those who only get SSI) plus whatever their state gives to people on SSI (the Supplemental State Benefit.)

These people (in the paragraph above) would then get both Medicare and Medicaid. They are called "dual eligibles." Here is a source:

Dual Eligibility ? Medicare and Medicaid | The Medicare & Medicaid Center

What is important to remember is that it is the federal government who decides if you qualify for basic SSI - not the state government. The state only decides if they want to add something to the SSI.

One of the things the state can add is to pay the part B premium for low income people on Medicare. It can also pay that for people who get no SSI. I get that. In my state, that benefit is called a form of Medicaid. The state Medicaid people administer that benefit. That is true in most states, but maybe not in every state.

There are people who do get total Medicaid piggybacked on to Medicare, as I said further up . . . and those are the "dual eligibles." There are plenty of doctors who accept Medicare, but don't accept Medicaid. On the other hand, it would be very odd for a doctor to accept Medicaid, but refuse to accept Medicare, since Medicare pays the docs better than Medicaid. But it possibly could happen. A doctor certainly can accept both Medicare and Medicaid. As you say, doctors who accept Medicaid often tend to be the bottom of the barrel. As you say, few doctors can afford to not accept Medicare. Those who do reject it include doctors who cater to the very, very rich.

When people have both full Medicare and full Medicaid, Medicare is the primary insurer and Medicaid is the secondary insurer. Medicaid would pick up co-pays, for instance.

It is true that people who only have Medicaid do sometimes get care that is not the best. Sometimes they do have trouble finding doctors. State certainly can differ in how well they compensate doctors who accept Medicaid.

Like you, I get my Medicare Part B premium paid for by my state. As with you, I do not have a Medicaid card. I only have my Medicare card. A doctor seeing me would actually have no way of knowing that I get a state subsidy to pay the Part B premium and no reason to care that I do. It does not affect what he or she gets paid. In my state, I get letters saying that Income Support in my state is paying my Part B premium for me as a form of limited Medicaid assistance. Here is a link that shows that most (and possibly all) states call that assistance "Medicaid," even though it doesn't get you a Medicaid card:

Getting help to pay Medicare Part A and/or Part B premiums (the Medicare Savings Programs)

Excerpt:

You automatically qualify for Extra Help if you have Medicare and one of these:

Full Medicaid coverage

You get help from your state Medicaid program paying your Part B premiums (in a Medicare Savings Program)

You get Supplemental Security Income (SSI) benefits

("Extra Help" is a federal program for low income people that helps pay for prescriptions. It is also called "Medicare Low Income Subsidy for Prescriptions," and I get it. Thanks to that program, I pay no more than two dollars and change for a month's worth of any prescription.)

Like you, I was very concerned about having insurance that is portable across state lines. As with you, the fact that my state pays my Part B premium does not affect my Medicare being portable. As you say, full Medicaid does not typically cross state lines. (Actually, I think in case of an unforeseeable emergency, it can, but I don't really know.)

I think I've got this stuff straight, but, if anything is challengable, I would be glad to have that pointed out. Thanks for your post above correcting something I had got wrong.

Incidentally, a good example of a large population that gets both Medicare and Medicaid is the large population of persons living in nursing homes who cannot afford to pay the nursing home out of their own money.

Medicare will pay for stays in a nursing home, only if it's for some acute medical condition, like recovering from big-deal surgery. If you need nursing home placement because you are just unable to do ordinary things like bathe and feed yourself, perhaps - say - due to dementia, then you must pay for that. (or, someone, like a rich relative, must pay for you.) If you absolutely can't pay for a nursing home, yourself, and it would be unsafe for you to be left alone at home, then you qualify for your state's Medicaid - full benefits. If you already had Medicare, you would keep that and, also, have full Medicaid. Medicaid would pay for the nursing home care. It would also supplement Medicare in paying for your doctor and prescription bills.

Needless to say, being in a nursing home on Medicaid can, possibly, be an unfortunate way to end up in life. The quality of that care can vary hugely from state to state.